The Occupational Health Branch (OHB) of the California Department of Health Services (DHS) proposes to further develop and enhance its surveillance system for the detection and prevention of occupational carpal tunnel syndrome (CTS). For the past two years, we have been conducting CTS case ascertainment and performing selected work site investigations. We propose to enhance the current CTS surveillance system by expanding and evaluating case ascertainment tools; conducting telephone interviews of workers in high risk industries and occupations; increasing case-based field investigations, hazard identification, and prevention activities; and using the results of these efforts to foster prevention activities. This comprehensive system will use the existing SENSOR case definition and will employ protocols and methodologies easily adopted as a model by other states. The program will expand data collection to include electronically transmitted workers' compensation data, which will update our system to be consistent with national trends in information transfer and create a model more easily adopted by other states. Workers with CTS in high-risk industries and occupations will be interviewed by telephone using a standardized questionnaire to identify risk factors that can lead to prevention strategies. Work site investigations will be expanded in order to identify prevention methods and hazard reduction. Findings from all activities will be widely disseminated in the form of reports, educational materials, and scientific publications. The proposed enhanced surveillance program will be evaluated using established criteria such as timeliness, sensitivity, simplicity, flexibility, representativeness and acceptability. By building on the solid foundation of current surveillance activities, we believe we can achieve the goal of building a model work-related carpal tunnel surveillance program that can be used to prevent this important occupational disease in California and in other states.